Friday, 11 May 2018

Otago and disagreement

Every time I think that the University of Otago's Public Health people can't get any worse, they go and surprise me.

Today, the Initiative launched Jenesa Jeram's excellent report on vaping and reduced-harm alternatives to smoking. It walks through the evidence on the risks of vaping, heat-not-burn products, and snus, and makes some recommendations around liberalising access so that smokers might be able to choose ways of getting nicotine that don't involve breathing in smoke.

The report has drawn some reasonable support. Here's Action on Smoking and Health:
And here's Massey University's Prof of Public Health, Marewa Glover:
The Science Media Centre ran a bit of an expert round-up. They asked Massey Health Sciences Senior Lecturer Dr Penelope Truman, who had a lot of sensible things to say:
“I welcome this policy input from the New Zealand Initiative.

“New Zealand has been at the forefront of tobacco control initiatives, with strong and largely successful policies in such matters as tobacco tax increases, restrictions on the places where people can smoke, restricting point of sale displays and, recently, introducing plain packaging.

“However, decreases in smoking rates in New Zealand have slowed, particularly for some groups (including Māori). Further, tax increases have reached the stage of encouraging illegal activity, such as the much-publicised dairy robberies. Smoking addiction is bearing especially heavily on those households with a low disposable income, and onlookers are increasingly questioning the ethics and efficacy of taking our ‘force them to quit’ approach to smoking cessation much further.


“The major worry, of course, is that vaping may become attractive to children and teenagers, become a gateway to nicotine addiction and, from there, encourage smoking. While it is obvious that youth are experimenting with vaping, I have never yet found anyone who can explain to me why, if e-cigarettes are a gateway to smoking, youth smoking is declining markedly everywhere that vaping is available.

“My reading of the data is that young people may experiment and may even take up vaping for a while (with or without nicotine) but that vaping diverts a significant proportion of those who might otherwise have taken up smoking from ever doing so. This may well be because nicotine by itself, in any form, is just not as addictive as smoking is.

“In the meantime, we have over 600,000 New Zealand smokers, who have not yet stopped smoking in spite of all the pressure to do so. The indications currently are that many might stop or reduce smoking if vaping were to become more readily available as a substitute, while very few non-smokers will take up vaping, beyond short-term experimentation.”
Lots of agreement on the importance of reduced-harm alternatives.

But Science Media Centre also asked Janet Hoek and Richard Edwards. Otago University. Here's their take on Jenesa's report.
“The dismissal of effective public health measures is perhaps unsurprising for a group funded in part by the three largest tobacco companies operating in New Zealand (British American Tobacco, Imperial Tobacco and Philip Morris). These are the companies already making or developing the ‘Heat not Burn’ products that the report promotes.

“We recommend that readers refer to an action plan developed following broad consultation with the New Zealand tobacco control sector. This sets out a multi-faceted strategy comprising an intensification of current approaches, including enhanced support for smokers wishing to quit; implementation of cutting-edge methods to reduce the affordability, availability, appeal and addictiveness of smoked tobacco products, and making nicotine-containing e-cigarettes and e-liquids widely available to smokers who wish to use them to help quit or as substitutes for smoking if they cannot or do not wish to quit.

“This comprehensive and evidence-based plan is far more likely to succeed than a limited approach that seems inspired more by the corporate interests of its backers than any real desire to achieve the Smokefree 2025 goal. It is difficult to view Ms Jerram’s report as anything other than ‘prugging’ – PR under the guise of research.”
So Action on Smoking and Health, Dr Truman and Prof Glover welcomed the report. Edwards and Hoek didn't like it - and that's fine. People can disagree. But what isn't fine is Edwards and Hoek's assertions around why our report isn't what they'd have written. They think our report reaches different conclusions than they've reached because the Initiative is a member-funded organisation and we have tobacco company members.

And yet ASH, and others in public health, agreed with the report - or at least found it well-informed and accurate. Are they somehow bought out by industry? I could understand people starting to question our intentions if there had been a bunch of errors or strange interpretations in it that all skewed one way, but it's Otago that's the outlier here - not us.

Our report recommends a regulatory framework that would keep the playing field open to new products and new producers. That hardly favours big players. A recommendation for very costly pre-market testing for every new product and every new flavouring would effectively lock the whole thing up such that only the largest companies could participate - and discourage people from switching away from traditional smoked tobacco. That is not what we recommended.

This is basic regulatory economics. Big companies are able to front the fixed costs of dealing with costly regulatory systems, and little guys aren't. That's why big companies sometimes welcome regulatory frameworks that sound like they'd be harmful to them - it hurts their competitors more. One of my favorite stories on that one was American washing machine manufacturers welcoming costly energy efficiency standards because, while it hurt them, it devastated the cheap imports then available. It hurt the competitors more. A lot of regulation is like that.

Otago simply seems unable to conceive of that people can disagree with them honestly - even though a good chunk of the New Zealand tobacco harm reduction academic community seems to disagree with them. Could it be possible that we disagree with Otago for reasons like those listed by Dr Truman?

And they couldn't even spell Jenesa's name correctly. It's Jenesa Jeram. Not Jerram.

I'm damned proud of Jenesa's report. And Otago's Public Health department is a disgrace to academia.

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